Mucocutaneous Manifestations of Drug Abuse at a Glance
- The morphology and arrangement of skin lesions can identify persons with former and current drug dependency.
- Skin lesions associated with drug use can be related directly to the drug itself, mode of drug delivery, and/or adulterants or infectious agents mixed with the drug.
- Drug addiction-related bacterial infections predominantly involve the skin and soft tissue. Culture-guided antibiotic therapy is essential because infection with unusual organisms, antibiotic-resistant strains, and polymicrobes is more common.
- Behavioral effects of drug use can lead to the transmission of sexually transmitted diseases and blood-borne pathogens including Treponema pallidum, hepatitis B virus, hepatitis C virus, human immunodeficiency virus, and human T-lymphotropic viruses 1 and 2.
Drug abuse and addiction can be suspected or diagnosed on the basis of mucosal and cutaneous findings. The administration of drugs may cause cutaneous stigmata and eruptions predominantly through local or systemic, toxic or hypersensitivity-induced effects as a result of the drug itself, adulterants, infectious agents, or the mode of drug delivery.
Illicit drug use is a maladaptive pattern involving self-administration of prescribed or recreational drugs. Chipping is a lay term used to describe a pattern of drug use in which the user is not physically dependent, but rather sustains “controlled use” of a drug. A certain percentage of users will progress to drug dependence, a physical and/or psychological need for the effects of a chemical in order to avoid withdrawal symptoms associated with abstinence (Box 105-1). Drug dependence often leads to drug abuse, an intense desire to recurrently obtain increasing amounts of one or more chemical substances to the exclusion of all other activities, resulting in clinically significant physical, emotional or social distress (Box 105-2). Tolerance defines a physiologic state in which progressive increases in the dose of a drug are needed to achieve the effects previously experienced at smaller doses. Some drugs chiefly induce physical dependence, while cause predominantly psychological dependence.1
Box 105-1 Criteria for Drug Dependence |Favorite Table|Download (.pdf)
Box 105-1 Criteria for Drug Dependence
The presence of three or more of the following, occurring any time in the same 12-month period:
- Withdrawal symptoms
- Sustained intent or unsuccessful efforts to abate drug use
- Administration of drug in higher doses and longer duration than initially intended
- Significant time devoted to obtaining the drug or recovering from its effects
- Relinquishment or reduction of social, occupational or recreational activities because of drug abuse
- Continued drug use despite awareness of the presence of a persistent or recurrent physical or psychological problem caused or exacerbated by the drug
Adapted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders IV-TR, 4th edition. Washington DC, American Psychiatric Press, 2000.
Box 105-2 Criteria for Drug Abuse